Drug Metabolism in Liver Failure

  • Simon W. Lam


The liver is involved in the metabolism and elimination of many medications entering the body and liver disease leads to widespread alterations in drug pharmacokinetics and pharmacodynamics. An understanding of physiologic changes during liver disease and their corresponding effects on drug disposition will be useful for clinicians to optimize therapy and avoid adverse reactions. This chapter describes the complex relationship between drug properties and drug metabolism in liver failure. In addition, it will illustrate the effects of liver failure on the metabolism of specific classes of medications that are frequently used in anesthesiology and critical care such as sedatives, opioids, and neuromuscular blocking agents.

Pharmacokinetics (PK) and Pharmacodynamics (PD)

Any medication entering the body follows a unique process: absorption , distribution, metabolism, and elimination. This process ultimately determines how much drug is available at the targeted site...


Cytochrome P450 Glucuronidation Oxidation Half-life Metabolism Pharmacokinetics Pharmacodynamics Liver failure Sedatives Opioids Neuromuscular blockade 







Hepatic clearance


Hepatic extraction


Intrinsic clearance


Fraction unbound


Hepatic blood flow


Volume of distribution




Gamma-aminobutyric acid






Maximum concentration


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Cleveland ClinicClevelandUSA

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